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HIV INFECTION

HIV INFECTION. D - preventive Medicine. HIV INFECTION LEARNING OBJECTIVES. Describe the pathophysiology of HIV infection. Describe the principal mechanisms of transmission of HIV infection. Describe the diagnostic algorithm for HIV infection.

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HIV INFECTION

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  1. HIV INFECTION D - preventive Medicine

  2. HIV INFECTION LEARNING OBJECTIVES • Describe the pathophysiology of HIV infection. • Describe the principal mechanisms of transmission of HIV infection. • Describe the diagnostic algorithm for HIV infection. • Describe measures for prevention and treatment of HIV infection.

  3. HIV INFECTIONVIRAL STRUCTURE

  4. HIV INFECTIONVIROLOGY • RNA retrovirus • Two major strains - HIV 1 and HIV 2

  5. HIV INFECTION VIRAL STRUCTURE

  6. HIV INFECTIONKEY VIRAL ENZYMES • Reverse transcriptase • Integrase • Protease

  7. HIV INFECTIONPATHOPHYSIOLOGY

  8. HIV INFECTIONPATHOPHYSIOLOGY

  9. HIV INFECTIONGENETIC DIVERSITY

  10. HIV INFECTIONGENETIC DIVERSITY • Replication cycle - 2.5 days • 1 billion virions each day • 10 trillion virions during course of illness

  11. STAGES OF HIV INFECTION • Acute retroviral illness • Latent phase • Symptomatic phase • AIDS

  12. MOST COMMON SERIOUS OPPORTUNISTIC DISEASES • Pneumocystis jiroveci(carinii) pneumonia • Kaposi’s sarcoma • MAC

  13. OTHER IMPORTANT OPPORTUNISTIC DISEASES • TB • Toxoplasmosis • CMV infection • Candidiasis • Non-Hodgkin’s lymphoma

  14. PRINCIPAL MECHANISMS OF TRANSMISSION • Sexual contact • IVDU • Perinatal

  15. EPIDEMIOLOGY OF HIV INFECTION Million cases

  16. EPIDEMIOLOGY OF HIV INFECTION IN THE U.S.

  17. EPIDEMIOLOGY OF HIV INFECTION IN MEN IN THE U.S.

  18. EPIDEMIOLOGY OF HIV INFECTION IN MEN IN THE U.S.

  19. EPIDEMIOLOGY OF HIV INFECTION IN WOMEN

  20. EPIDEMIOLOGY OF HIV INFECTION IN WOMEN

  21. RISK FACTORS FOR SEXUAL TRANSMISSION • Multiple sexual partners • Receptive anal intercourse • Unprotected intercourse • IVDU

  22. RISK FACTORS FOR SEXUAL TRANSMISSION • Crack cocaine use • Ulcerated genital lesions • Uncircumcised male

  23. RISK FACTORS FOR SEXUAL TRANSMISSION • Severity of illness in index case • Sex during menstruation • Bleeding during intercourse

  24. DIAGNOSIS OF HIV INFECTION • Screening test – enzyme immunoassay (EIA) • Confirmatory test • Western blot • Immunofluorescent assay (IFA)

  25. ETIOLOGY OF PEDIATRIC HIV INFECTION

  26. MECHANISMS OF PERINATAL TRANSMISSION OF HIV

  27. FREQUENCY OF VERTICAL TRANSMISSION OF HIV Percent

  28. HIV INFECTIONMANAGEMENT • Antiretroviral therapy • Prophylactic antibiotics • Immunizations

  29. HIV INFECTIONANTIRETROVIRAL AGENTS • Nucleoside reverse transcriptase inhibitors • Non-nucleoside reverse transcriptase inhibitors • Protease inhibitors • Entry (fusion) inhibitors

  30. HIV INFECTIONCRITERIA FOR TREATMENT • Early symptomatic illness • CD 4 count < 200/mm 3 • Relatively high viral load (> 30,000 copies/ml) • Later symptomatic illness • Pregnancy – prevention of perinatal transmission

  31. HIV INFECTIONEFFECTS OF TREATMENT • Prolonged survival • Improved quality of life Level I evidence

  32. HIV INFECTIONPROPHYLACTIC ANTIBIOTICS

  33. HIV INFECTIONPROPHYLACTIC ANTIBIOTICS

  34. HIV INFECTIONVACCINATIONS • Hepatitis A • Hepatitis B • Meningococcal vaccine

  35. HIV INFECTIONVACCINATIONS • Pneumococcal vaccine • Influenza vaccine

  36. PREVENTION OF HIV INFECTION

  37. PREVENTION OF HIV INFECTION • Avoid IVDU • Avoid occupational injury

  38. PREVENTION OF HIV INFECTION

  39. PREVENTION OF INFECTION

  40. POST SEXUAL EXPOSURE PROPHYLAXIS • Drugs - ZDV + 3TC + nelfinavir • Duration - 28 days • Cost – approximately $1000 Level III evidence

  41. RISK FACTORS FOR OCCUPATIONAL INFECTION • Deep injury • Visible blood on the device • Indwelling needle in artery or vein • Terminal illness in source patient • Failure to receive prophylaxis

  42. PROPHYLAXIS FOR OCCUPATIONAL EXPOSURE • High risk - ZDV + 3TC + nelfinavir • Low risk - ZDV + 3TC Level II evidence

  43. HIV INFECTIONCONCLUSIONS • Enormity of the public health problem • Mechanisms of transmission • Treatment and preventive measures

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