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Comprehensive HIV/AIDS Clinical Management by Dr. K. Bujji Babu, MD

Learn about the clinical management of HIV/AIDS and skin conditions at Dr. Bujji Babu HIV Clinic in Suryaraopet, Vijayawada. Topics include opportunistic infections, antiretroviral treatment, mother-to-child transmission, psychosocial issues, and ethical considerations. Understand HIV transmission, WHO classification, CDC revised classification, and goals in HIV care. Explore the course of HIV infection, opportunistic infections, diagnostic methods, antibiotic treatment, pulmonary manifestations, cutaneous manifestations, and more.

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Comprehensive HIV/AIDS Clinical Management by Dr. K. Bujji Babu, MD

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  1. HIV/AIDS – CLINICAL MANAGEMENT Dr.K.BUJJI BABU, MD.,STD, HIV/AIDS & Skin Dr.Bujji Babu HIV Clinic Suryaraopet, Vijayawada

  2. GOALS • Opportunistic infections • Antiretroviral treatment • Mother-to-Child Transmission • Psychosocial issues • Ethics

  3. HIV TRANSMISSION • Exchange of body fluids • Exchange of infected blood transfusion or by needle piercing • Mother-to-child transmission • 80-90% sexual contact

  4. WHO Classification • Major signs - Weight loss >10% of body weight - Fever more than one month int & cont - Chronic diarrhoea more than one month intermittent and continues

  5. WHO Classification • Minor signs - Persistent cough more than one month - Gen.itchydermatitis - Recurrent, multi-dermatomal herpes zoster - oral candidiasis - Chronic progressive and disseminated herpes simplex - Generalized lymphadenopathy

  6. CDC REVISED CLASSIFICATION • CD4 T-cell A B C >500/ul A1 B1 C1 200-499/ul A2 B2 C2 <200/ul A3 B3C3 A- Asymptomatic or PGL B- Symptomatic C – AIDS indicator

  7. CLASSIFICATION (CD4) • CD4 cell count/ul Stage of HIV disease >500 Early 500 – 200 Intermediate 200 – 50 Late or severe <50 Far Advanced

  8. FIVE GOALS IN HIV CARE • Prevention of further transmission • Preservation of immune function • Prophylaxis against OI • Rx of OI through effective early diagnosis • Counseling and other psychosocial supports

  9. COURSE OF HIV INFECTION • Acute seroconversion syndrome in 1/3rd • Phase of clinical latency • CD4 <200/ul, OI begins to set • Progress to AIDS about 8-10 yrs

  10. OPPORTUNISTIC INFECTIONS • Oral candidiasis - Oral discomfort - Burning sensation when eating - Altered sense of taste - KOH • Oesophageal candidiasis - Odynophagia or dysphagia - Anterior chest pain, exacerbated by swallowing

  11. OPPORTUNISTIC INFECTIONS - DIARRHOEA • Parasitic – Criptosporidium, Isosporabelli Microsporidia, Giardia, EH • Bacteria – Solmonella, Campylobacter, C.difficile, M.tuberculosis

  12. DIARRHOEA • Fungal – Candidiasis, Histoplasmosis • Viral - CMV, HSV, adenovirus, enterovirus, HIV • M.C - Cryptosporidium, Isospora belli & Microsporidium

  13. EMPIRIC ANTIBIOTIC RX • TMP/SMX • Ciprofloxacin • Metronidazole • Paramomycin

  14. COUGH & FEVER • Acute – WBC + abundant bacteria • Sub acute – Few WBC – PCP • Chronic – AFB+ - TB • Malaria, Typhoid, Viral fever • Crypto • Toxo

  15. CNS MANIFESTATIONS • Cryptococcal meningitis • Toxoplasmosis • Tuberculous meningitis • Progressive multi focal leukoencephalopathy • Neurosyphilis • Lymphoma

  16. CT scan post contrast multiple granulomas (arrows) surrounded by minimal vasogenic edema. Presence of multiple lesions with a target sign and positive toxoplasma titre suggest toxoplasmosis

  17. PULMONARY MANIFESTATIONS • Pansinusitis • Pulmonary or extra pulmonary tuberculosis • PCP • CMV

  18. CUTANEOUS MANIFESTATIONS • Infectious dermatoses Viral infections Acute HIV, HSV, VZV EBV HPV

  19. BACTERIAL INFECTIONS • Staphylococcal • Mycobacterial • Bacillary angiomatosis • T.Pallidum infection • Others – Pseudo, salmo, nocardia

  20. FUNGAL INFECTIONS • Superficial dermatophytosis • Candidiasis • Superficial mycoses • Deep infections & systemic mycoses Crypto, histo, coccidio, sporotrichosis, penicilliosis, blastomycosis, aspergillous

  21. PARASITIC INFECTIONS • Arthropod infestations Scabies, demodicidosis • Protozoal infestations Ex-pulmonary pneumocystosis, leishmaniasis, cutaneuous toxo, acanthamoebiasis

  22. NON-INFECTIOUS DERMATOSES • Seborrheic dermatitis, psoriasis, Reiter’s, ichthyosiform dermatoses • Papular and follicular eruption of HIV • Pigmentary idsorders • Adverse cutaneous drug reactions • Neoplasms: Kaposi’s, lymphoma, melanoma

  23. NAIL & HAIR CHANGES • Onychomycosis • Yellowish discoloration of nail • Melanotic bands & black pigmentation of nail due to AZT • Pre-mature graying of hair (Canities) • Diffuse hair loss, male pattern alopecia, alopecia areata, hypertrichosis of the eye lashes

  24. STIs & HIV • Severe/extensive • Atypical/chronic • No response/minimal response to standard Rx • Precocious syphils • TPHA & FTA – ABS – Positive

  25. STIs • Syphilis, herpes, chancroid, granuloma inguinale, LGV, gonorrhea, trichomoniasis, bacterial vaginosis, vulvovaginal candidiasis, PID, ano-genital warts

  26. MANAGEMENT • WHO(1997) CDC (1998) • Higher dose of antimicrobials • Prolonged duration of therapy

  27. OCCULAR MANIFESTIATIONS IN HIV • Conjunctivitis • Karatitis • CMV retinopathy • TB retinopathy • Sudden retinal detachments

  28. ENT MANIFESTATIONS IN HIV • Oropharyngeal candidiasis • Middle ear disorders • Pan sinusitis

  29. RENAL MANIFESTATIONS IN HIV

  30. GIT MANIFESTATIONS IN HIV • Acute gastric & duodenal ulcers • Acute, sub acute, chronic cholecystitis • Hepatitis – HBV, HCV, HIV, CMV • Pancreatitis • Small bowel disorders • Large bowel disorders • Rectum, anal canal & perianal disorders

  31. HAEMATOLOGICL DISORDERS IN HIV • ANAEMIA

  32. CVS IN HIV • Atherosclerosis due to CMV • Cardiomyopathy due to CMV • Cardiomyopathy due to anaemia • CCF

  33. WOMEN & HIV • OI in women as same in men • Recurrent vulvovaginal candidiasis • Genital herpes, HPV • Bacterial vaginosis & PID • Cervical dysplasia and neoplasia

  34. PAEDIATRIC HIV • Diagnosis based on antibody tests >18 M • Immediate diagnosis – antigen test DNA PCR, p24 antigen

  35. ANTI-RETROVIRAL THERAPY • Clinical goal • Virological goal • Immunological goal • Therapeutic goal • Epidemiological goal

  36. INDICATIONS FOR ART • Acute infection • Symptomatic • Asymptomatic - CD4 <200 to 500 - HIV RNA >20,000 copies - RT-PCR >10,000 copies bDNA

  37. ART • NRTI – AZT, ddI, ddC, d4T, 3TC • NNRTI – Nevi, delavir, efavir • PI - Saq, ritonavir, ind, nelf, ampri • Nucleotides – adefovir, dipivoxil • Miscellaneous – Hydroxurea

  38. COMBINATION OF ART • Mono therapy • Duel therapy • Highly active antiretroviral therapy • Salvage therapy (rescue therapy) • Recycling therapy • Mega-HAART • Subtraction regimen (step down therapy)

  39. ART IN TB • No ART with Rifampicin • Dual nucleoside therapy during rifampicin • Triple therapy with Rifabutin • Triple therapy with PI only with Ethambutol & INH regimen

  40. PREVENTION OF MOTHER-TO-CHILD TRANSMISSION • ART before, during, after delivery • Infant: AZT syrup 2mg/kg/QID for first six weeks, 8 to 12 hours after birth • LSCS • Postpartum care • Breast feeding with ART

  41. PSYCHOSOCIAL MANAGEMENT • Counseling - Relationship building - Assessment - Goal setting - Intervention - Termination & follow up

  42. ETHICS • Obligation of a physician to treat patients - World medical association (the professional responsibility of physicians in treating AIDS patients) should not refuse to treat a patient, a physician who is not able to provide care and service should refer to equipped hospitals.

  43. ETHICS • Confidentiality - If individual feels that their status will be disclosed and in turn lead to discrimination, they may opt to get tested or treated, and that hinders offers to contain the epidemic

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