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AIDS

AIDS. Dr. Meg- angela Christi Amores. AIDS. Etiologic agent: HIV (Human Immunodeficiency Virus) 2 types: HIV 1 and HIV 2 Most common cause: HIV 1. Replication and CD-4 involvement. Classification.

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AIDS

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  1. AIDS Dr. Meg-angela Christi Amores

  2. AIDS • Etiologic agent: • HIV (Human Immunodeficiency Virus) • 2 types: HIV 1 and HIV 2 • Most common cause: HIV 1

  3. Replication and CD-4 involvement

  4. Classification • categorizes persons on the basis of clinical conditions associated with HIV infection and CD4+ T lymphocyte counts

  5. Classification • Category A • Asymptomatic HIV infection • Persistent generalized lymphadenopathy • Acute (primary) HIV infection with accompanying illness or history of acute HIV infection

  6. Category B • Bacillary angiomatosisCandidiasis, • oropharyngeal (thrush) • Candidiasis, vulvovaginal; persistent, frequent, or poorly responsive to therapy • Cervical dysplasia • Constitutional symptoms • Hairy leukoplakia • oral Herpes zoster (shingles), involving at least two distinct episodes or more than one dermatome • Idiopathic thrombocytopenic purpura • Listeriosis • Pelvic inflammatory disease, particularly if complicated by tuboovarian abscess • Peripheral neuropathy

  7. Category C: Conditions listed in the AIDS surveillance case definition.

  8. The definition of AIDS is complex • Not focus on whether or not patient fulfills strict definition • View HIV disease as a spectrum

  9. Transmission • transmitted by both homosexual and heterosexual contact; • by blood and blood products; • and by infected mothers to infants either intrapartum, perinatally, or via breast milk

  10. Sexual Transmission • HIV infection is predominantly a sexually transmitted disease (STD) worldwide • Mostly male to male contactin US • But heterosexual is more common in developing countries • male circumcision is associated with a lower risk of HIV infection among men

  11. Sexual Transmission • concentrate in the seminal fluid, esp. in genital inflammatory states such as urethritis and epididymitis, conditions closely associated with other STD • cervical smears and vaginal fluid • strong association of HIV transmission with receptive anal intercourse • More male to female than female to male

  12. Other sexual issues • Oral sex is a much less efficient mode of transmission of HIV than is receptive anal intercourse • association of alcohol consumption and illicit drug use with unsafe sexual behavior leads to an increased risk of sexual transmission of HIV

  13. Transmission by blood and blood products • receive HIV-tainted blood transfusions • transplanted tissue • sharing injection paraphernalia such as needles, syringes, the water in which drugs are mixed • Do not require IV (intravenous pucture), even SC and IM can transmit

  14. Occupational Transmission: Health workers • small, but definite, occupational risk • 600,000–800,000 health care workers are stuck with needles in the US • risk of HIV transmission following skin puncture from a needle or a sharp object that was contaminated with blood from a person with documented HIV infection is ~0.3% and after a mucous membrane exposure it is 0.09%

  15. Maternal-Fetal/Infant Transmission • during pregnancy, during delivery, or by breast-feeding • HIV can be transmitted to the fetus as early as the first and second trimester • most commonly in the perinatal period • risk of HIV infection via breast-feeding is highest in the early months of breast-feeding

  16. Clinical Manifestations • Acute HIV Syndrome • 3–6 weeks after primary infection • fever, skin rash, pharyngitis, and myalgia • usually persist for one to several weeks and gradually subside

  17. Clinical Manifestations • The Asymptomatic Stage—Clinical Latency • median time for untreated patients is ~10 years • active virus replication is ongoing and progressive • Ave. rate of CD4+ T cell decline is ~50/uL per year • <200/uL – level at which risk for opportunistic infections is high

  18. Clinical Manifestations • Symptomatic Disease • can appear at any time • diagnosis of AIDS is made in anyone with HIV infection and a CD4+ T cell count <200/uL • anyone with HIV infection who develops one of the HIV-associated diseases considered to be indicative of a severe defect in cell-mediated immunity

  19. AIDS - symptomatic • Pneumocystisjiroveci – pneumonia • MTB • Toxoplasmosis – • Varicella • Cryptococcus neoformans – cryptococcosis • Histoplasmacapsulatum

  20. Management • ELISA - standard blood screening test • Antibodies to HIV generally appear in the circulation 2–12 weeks following infection • most commonly used confirmatory test is the Western blot • Monitoring: CD4+ T Cell Counts • Indicator of the immediate state of immunologic competence of the patient

  21. Management • Combination antiretroviral therapy (ART), or highly active antiretroviral therapy (HAART), is the cornerstone of management of patients • Reverse Transcriptase Inhibitors (Ziduvudine) • Protease Inhibitors(Saquinavir) • Entry Inhibitors • Suppression of HIV replication is an important component in prolonging life

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